Belitung Nursing Journal最新文献

Background: Low birth weight (LBW) is a major global health concern because of its strong association with infant mortality, morbidity, and impaired long-term development. The determinants of LBW among neonates in rural areas of Indonesia remain underexplored.

Objective: To examine the prevalence of LBW and determine its associated factors among neonates in rural areas of Indonesia.

Methods: A cross-sectional study used secondary data sources from the 2017 Indonesian Demographic and Health Survey. A total of 6,701 mothers who lived in rural areas were included. Explanatory variables were maternal age, maternal education, smoking status, parity, birth interval, twin history, antenatal care (ANC), husband support, wealth quintile, region of residence, and complications during pregnancy. The outcome variable was the prevalence of LBW. Data were analyzed using bivariate analysis with a Chi-square test (χ²) and multivariable logistic regression.

Results: The prevalence of LBW was 6.65%. First birth [AOR = 1.486; 95% CI: 1.126-1.959], twin history [AOR = 27.165; 95% CI = 13.006-56.738], fewer than four ANC visits [AOR = 2.193; 95% CI = 1.519-3.164], and complications during pregnancy [AOR = 1.890; 95% CI = 1.427-2.503] were significantly associated with the prevalence of LBW.

Conclusion: This study revealed the prevalence of LBW among neonates in rural areas of Indonesia. First birth, twin history, ANC visits, and complications during pregnancy were significantly associated with LBW. It is suggested that health professionals should strengthen the quality of antenatal care and improve health promotion and education during pregnancy for rural mothers to reduce the prevalence of LBW.

Background: Transitioning to fatherhood for the first time is a significant milestone in a man's life, especially among first-time expectant fathers having couvade syndrome, which causes them to experience changes both physically and psychologically. However, there is a lack of existing research on the process of transition to fatherhood among first-time expectant fathers having couvade syndrome.

Objective: This study aimed to explore the process of transition to fatherhood among first-time expectant fathers having couvade syndrome.

Methods: This study adopted a constructivist grounded theory methodology. Participants included 20 first-time expectant fathers having couvade syndrome who were purposively selected from antenatal clinics of two hospitals in northern Thailand. Data were collected between March 2021 and October 2023 using in-depth interviews following Charmaz's steps. Data were corrected and analyzed until theoretical saturation.

Results: "Evolving new father's role over couvade syndrome" emerged as the core category representing their transition into fatherhood. This process consisted of three phases. Phase I was experiencing couvade syndrome that involved confirming couvade syndrome and responding to couvade syndrome. Phase II focused on handling couvade syndrome by accepting it and adapting behaviors. Phase III was stepping into the father's role as couvade syndrome symptoms resolved, encompassing freaking out about the new father's role, dealing with it, and planning for raising the baby.

Conclusion: This study generated new knowledge regarding the transition to fatherhood among first-time expectant fathers experiencing couvade syndrome that involves three phases: in early pregnancy, around the middle of pregnancy, and towards the end of pregnancy. The insights can be used to inform nursing interventions to provide comprehensive, phase-specific antenatal care for these fathers.

Background: Most nursing students are female and represent a high-risk group for low back pain (LBP) before entering the workforce. However, the prevalence and specific predictors for LBP in this population remain poorly defined.

Objective: This study investigated the prevalence and predictive factors of LBP among a nationally representative sample of Thai female nursing students.

Methods: A cross-sectional online survey was conducted in 2022 among 3,490 female students from 18 nursing schools across Thailand. Data collected included demographics, online learning habits, psychological health, and LBP perceptions. Binary logistic regression was used to identify predictors of LBP. A p < 0.05 was deemed significant.

Results: The seven-day period prevalence of LBP after six months of online learning was 39.5% (95% CI = 37.3-40.6). Factors significantly predicting LBP included anxiety [mild-to-moderate (AOR = 1.54, 95% CI = 1.31-1.82) and severe-to-extremely severe (AOR = 1.47, 95% CI = 1.13-1.91)], prolonged sitting (AOR = 1.52, 95% CI = 1.14-2.04), smartphone use for learning (AOR = 1.44, 95% CI = 1.23-1.68), bent posture (AOR = 1.33, 95% CI = 1.16-1.61), fatigue (per 10-point increase; AOR = 1.27, 95% CI = 1.11-1.46), and participation in online learning classes (AOR = 1.07, 95% CI = 1.02-1.12). Likewise, the final model demonstrated modest discriminatory power (AUC = 0.68, 95% CI = 0.63-0.74; p < 0.001). While the model significantly differentiates between students with and without LBP, its clinical utility is constrained by the condition's multi-factorial nature.

Conclusions: LBP is common among female nursing students and is driven by a combination of ergonomic and psychological factors. Nursing education programs should implement routine screening for both physical and mental well-being, alongside targeted preventive interventions to manage these modifiable risk factors before students enter professional practice.

Background: Indonesia is experiencing rapid population aging, raising concern about muscle weakness in later life; possible sarcopenia offers early identification through low handgrip strength.

Objective: To estimate the prevalence of possible sarcopenia and its determinants among older adults in Indonesia.

Methods: This secondary analysis used baseline data from the Indonesian Longitudinal Aging Survey 2023 and included adults aged sixty years or older with valid handgrip measurements. Possible sarcopenia followed the Asian Working Group for Sarcopenia 2019 thresholds using the maximum of two trials per hand. Covariates included sociodemographic, behavioral, functional, and clinical factors. We applied descriptive statistics, bivariate tests, and multivariable logistic regression, with probit average marginal effects. Sampling weights were unavailable in the public-use microdata; we treated enumeration areas as the primary sampling units, with available stratification and no weights; estimates were unweighted, and standard errors were design-based (survey-corrected).

Results: Among 1,598 participants, the prevalence of possible sarcopenia was 51.1%. Older age, low physical performance, and urban residence were associated with higher odds. Higher body mass index and better cognition were associated with lower odds. A prespecified sex-by-body mass index interaction suggested attenuation of the protective association of body mass index among women.

Conclusion: Possible sarcopenia is common among older Indonesians and is patterned by age, body composition, cognition, functional status, and residential context. Community health services, including community nursing services, can integrate routine handgrip assessment with brief interventions on strength activities, nutrition, and cognitive engagement to identify risk early and inform preventive care.

Background: Despite nurses' proximity to patient care, many remain reluctant to voice safety concerns. A significant gap exists in understanding how the professional work environment influences these behaviors within the Saudi Arabian context, where specific cultural and hierarchical norms may impact communication.

Objective: This study examined the relationship between nurses' speaking up regarding patient safety and the nursing work environment in Saudi Arabia.

Methods: A cross-sectional descriptive correlational design was used. Data were collected from 270 nurses between August and September 2024 using the Speaking Up About Patient Safety Questionnaire (SUPS-Q) and the Practice Environment Scale of the Nursing Work Index (PES-NWI). Statistical analyses were conducted using SPSS version 28, including descriptive statistics, Spearman's rank correlation, and ANCOVA.

Results: The nursing work environment showed a significant correlation with the speak-up climate. Weak but statistically significant negative correlations were found between perceived concerns and nurse participation (r = -0.210, p = 0.001), quality foundations (r = -0.155, p = 0.011), staffing adequacy (r = -0.184, p = 0.002), and nurse-physician relations (r = -0.156, p = 0.010). Withholding voice also negatively correlated with quality foundations (r = -0.149, p = 0.014) and nurse-physician relations (r = -0.138, p = 0.023). Psychological safety and an encouraging environment showed strong positive correlations with all work environment dimensions (p < 0.001). ANCOVA indicated that education level significantly predicted speaking up (p = 0.042), and experience influenced perceptions of the work environment (p = 0.002), while age and nationality were not significant.

Conclusion: Strengthening the work environment is a clinical necessity for safety. Organizations should prioritize "Just Culture" initiatives, systemic learning, and visible responses to raised concerns. Practice protocols should include "safe zones" for voicing concerns away from patients. Professional development must focus on communication skills for addressing high-authority figures. Finally, adequate staffing is essential to empower nurses to prioritize safety advocacy over basic tasks.

Background: Escalating emergency department overcrowding poses a serious threat to healthcare delivery, leading to reduced quality of care, increased risk of infection transmission, and heightened tension between medical staff and patients.

Objective: This study aimed to investigate the status of emergency department visits by young and middle-aged patients triaged as non-urgent and to explore the influencing factors.

Methods: This study retrospectively analyzed clinical data from 55,578 young and middle-aged patients who visited the emergency department of a tertiary class A hospital in Guangdong Province between January 1 and December 31, 2024. Patients were grouped into urgent and non-urgent based on triage classification. The differences in the clinical indicators between the two groups were compared. Logistic regression analysis was conducted to identify the factors associated with non-urgent triage classification.

Results: Among the included young and middle-aged patients, 35,314 (63.5%) were classified as non-urgent cases, while 20,264 (36.5%) were classified as urgent. Binary logistic regression analysis revealed that non-urgent triage classification was significantly associated with the following factors (p < 0.05): visiting Emergency Fever (OR = 1.513) and Emergency Gastroenterology (OR = 4.278) compared to Emergency Internal Medicine and Surgery; arriving on foot or by other modes (OR = 6.073) compared to ambulance transport; visiting during the afternoon shift (OR = 1.110) compared to morning shift, on weekends (OR = 1.111), and during the autumn (OR = 1.140) and winter seasons (OR = 1.083) compared to spring.

Conclusion: The rate of non-urgent triage among young and middle-aged patients is high. Triage nurses should be particularly vigilant in assessing patients presenting to departments with a higher likelihood of non-urgent classification, such as the Emergency Fever and Emergency Gastroenterology, as well as those arriving without ambulance transport, during non-working hours and peak flu seasons. These findings can inform nurse-led strategies, such as dynamic staffing and guiding appropriate patients to alternative services, such as internet hospitals, thereby mitigating emergency department overcrowding. It should be noted that in this study, non-urgent status was defined solely by the triage system and was not validated against clinical outcomes; therefore, the findings describe patterns of triage classification rather than objective patient acuity.

Background: Workplace bullying remains a pervasive problem in nursing, adversely affecting nurses' well-being and professional functioning. Prolonged exposure to bullying is associated with emotional exhaustion and job burnout. However, the potential buffering role of internal psychological resources, particularly psychological capital, has not been sufficiently examined.

Objective: This study aimed to explore the association between workplace bullying and job burnout among hospital nurses and examined whether psychological capital moderates this relationship.

Methods: A cross-sectional study was conducted with 209 nurses from two hospitals between July and September 2025. Data were collected using the Short Negative Acts Questionnaire, the Work-Related Burnout subscale of the Copenhagen Burnout Inventory, the Psychological Capital Questionnaire, and a demographic and professional characteristics form. Data analysis included descriptive statistics, independent t-tests, one-way ANOVA, Pearson's correlation coefficients, and moderation analysis using PROCESS macro (Model 1).

Results: Nurses reported moderate levels of workplace bullying (M = 2.31, SD = 1.12) and job burnout (M = 2.44, SD = 0.91). Psychological capital was relatively high (M = 4.89, SD = 1.08), including optimism (M = 4.93, SD = 1.09), hope (M = 4.96, SD = 1.13), self-efficacy (M = 4.77, SD = 1.19), and resilience (M = 4.89, SD = 1.17). Job burnout differed significantly across age groups (p = 0.043). Workplace bullying and job burnout varied by educational level (p = 0.019 and p = 0.021, respectively), and workplace bullying differed by gender (p = 0.001). Moderation analysis indicated that workplace bullying was positively associated with job burnout (B = 0.472, p < 0.001), whereas psychological capital was negatively associated with burnout (B = -0.135, p < 0.01). The interaction between workplace bullying and psychological capital was significant (B = 00.106, p < 0.01), indicating that psychological capital attenuated the positive association between workplace bullying and job burnout.

Conclusion: Psychological capital functions as a protective factor that buffers the adverse impact of workplace bullying on nurses' job burnout. These findings highlight the importance of strengthening nurses' psychological resources through organizational strategies and resilience-enhancing interventions to promote well-being and reduce burnout risk.

Background: Strengthening the quality of midwifery education is crucial to equip future midwives with the competencies required for contemporary practice. Continuity of Care (CoC) learning requires structured learning strategies, appropriate media, and effective evaluation mechanisms based on students' needs. In this context, mobile applications can support CoC learning through flexible documentation and reporting systems.

Objective: This study aimed to identify learning and competency needs for technology-enhanced CoC education among midwifery students.

Methods: A convergent mixed-methods design was employed with midwifery students in the Bandung Metropolitan Raya region, West Java, Indonesia, in 2024. Purposive sampling was used to select 310 students for quantitative analysis using STATA 16.0. Qualitative data from online focus group discussions (FGDs) with 34 students were analyzed using NVivo 1.6.1.

Results: Quantitative analysis identified learning strategy as the strongest predictor of CoC competency (r = 0.790, p < 0.001). Qualitative findings revealed two main themes: CoC Competencies (with subthemes of CoC Competency Objectives and CoC Core Competencies) and integrated CoC learning components (learning strategy, learning media, and learning evaluation).

Conclusion: This study identified four essential components of mobile-based CoC learning, with learning strategies emerging as the strongest predictor of competency. These findings indicate that, although mobile technology enables efficient recording and reporting, it must be integrated with structured learning strategies to effectively strengthen midwifery competencies.

Background: Nurses' perceptions of their nurse managers' leadership styles influence work motivation and turnover intention. However, limited evidence is available from Middle Eastern healthcare settings, particularly in Saudi Arabia.

Objective: This study aimed to examine the relationships between nurse managers' leadership styles, nurses' work motivation, and turnover intention, and assessed whether work motivation moderates the association between leadership styles and turnover intention.

Methods: A cross-sectional survey was conducted among 377 nurses working in governmental hospitals in Riyadh, Saudi Arabia, between January and March 2024. Leadership styles were measured across four dimensions: directive, supportive, participative, and achievement-oriented leadership. Data were analyzed using descriptive statistics, Pearson correlation analysis, and multivariate linear regression, followed by moderation analysis.

Results: The mean scores for supportive, participative, directive, and achievement-oriented leadership were 5.3 ± 1.0, 5.1 ± 1.0, 5.0 ± 1.0, and 4.9 ± 1.0, respectively. The mean scores for work motivation and turnover intention were 3.5 ± 0.9 and 3.1 ± 0.8. Correlation analysis indicated that all leadership styles were positively associated with work motivation, whereas only directive leadership was negatively associated with turnover intention. In multivariable regression analyses, after adjustment for sociodemographic and professional factors, achievement-oriented leadership remained significantly associated with higher work motivation (β = 0.51, p = 0.034), while directive leadership was independently and negatively associated with lower turnover intention (β = -0.15, p = 0.022). Nationality, educational level, years of experience, and working area were also significantly associated with turnover intention in adjusted models, while educational level and years of experience were associated with nurses' perceptions of leadership styles. Moderation analysis showed that work motivation did not significantly moderate the relationship between directive leadership and turnover intention.

Conclusion: Leadership styles were significantly associated with nurses' work motivation and turnover intention. Achievement-oriented leadership was linked to higher work motivation, while directive leadership was associated with lower turnover intention. These findings highlight the importance of strengthening nurse managers' leadership competencies to enhance nurses' motivation and potentially reduce turnover intentions in hospital settings.

Background: Nurse managers play a critical role in maintaining effective clinical operations and staff performance. However, research examining burnout and leadership efficacy in maternity care settings remains limited.

Objective: To examine burnout and leadership efficacy among nurse managers.

Methods: A sequential explanatory mixed-methods study was conducted at a tertiary maternity hospital in Doha, Qatar. In Phase I, 125 nurse managers were recruited through convenience sampling and completed the Maslach Burnout Inventory-Human Services Survey for Medical Personnel and the Leadership Efficacy Questionnaire. In Phase II, eight participants were purposively selected for in-depth interviews. Quantitative and qualitative findings were integrated using a joint display approach.

Results: Participants reported moderate emotional exhaustion (M = 22.85, SD = 12.69) and depersonalization (M = 7.40, SD = 5.31), alongside high personal accomplishment (M = 42.19, SD = 5.75). Leadership efficacy scores indicated moderate confidence across leader action, leader means, and self-regulation domains. Emotional exhaustion and depersonalization were negatively correlated with all domains of leadership efficacy, whereas personal accomplishment was positively correlated with them. Qualitative findings identified workload, staff management demands, and personal stressors as key contributors to burnout, while resilience, support systems, and adaptive coping strategies were associated with leadership efficacy. Integration indicated that burnout and leadership efficacy co-occur, with inverse associations suggesting that higher burnout is associated with lower leadership confidence, despite sustained functional performance.

Conclusion: Burnout and leadership efficacy are significantly associated among nurse managers. Although leadership functioning appears to be maintained, emotional strain is related to reduced leadership confidence. Organizational strategies that address workload demands, strengthen support systems, and promote resilience may help mitigate burnout and support leadership effectiveness.